We regularly hear that the harm (or risk) reduction approach is the perfect solution for working with individuals engaging in practices considered “at risk.” This approach is said to reduce the individual and social harms of a given practice in order to promote the well-being of the individual and the community. Its apparent success in HIV prevention (by providing users with access to clean needles) and the treatment of addictions at the user’s own pace (such as by prescribing methadone) has made it the model of choice for addressing other kinds of issues.

This has led certain social workers and activists calling for the legalization of prostitution to believe that this social issue also requires a harm reduction approach without giving too much thought to the nevertheless fundamental distinctions between prostitution and addictions to substances such as heroin or alcohol.

Marriage between the pro-prostitution lobby and the harm reduction approach

In the mid-1980s, some Western countries developed harm reduction programs that instead of requiring abstinence provided methadone and clean needles. Although the pro-abstinence approach continues to be favoured by supporters of the U.S. anti-drug approach and by European Cities Against Drugs (ECAD), the harm reduction approach has gone on to become a credible model for international organizations such as the UN and the World Health Organization. This harm reduction model as applied to drug use has been carried over to other areas, such as alcohol use and, the issue of interest here, prostitution. The harm reduction model was expanded in the 1990s through organizations that emerged at that time, such as the International Harm Reduction Association, and through publications such as the International Journal of Drug Policy. (1)

It was around this time that the movement to promote “sex work” began to take shape. The harm reduction approach, which by then had attracted significant interest, ended up laying the foundation for efforts to consolidate and legitimize “sex work.” Given that individuals in prostitution often had substance abuse problems, this helped introduce the harm reduction approach as a way to address prostitution. Since then, groups involved with “sex workers” have received funding from AIDS organizations such as Europap, the World Health Organization and UNAIDS. According to Melissa Farley, this well-meaning funding has helped to socially legitimize the sex industry. (2)

Projects using the harm reduction approach were conducted in emerging countries with large HIV-affected populations. For example, one project of this type was carried out in India in the 1990s, in Kolkata’s Sonagachi red light district. This project, which used a “pragmatic” harm reduction approach, was not aimed at challenging the institution of prostitution. On the contrary, its goal was to educate pimps and brothel owners about the importance of safe sex practices so that they would support the women in prostitution when they demanded clients wear a condom. While the official purpose of the project was to limit the spread of HIV and to empower prostituted women, it resulted in the project workers colluding with the pimps.

The point was to persuade brothel owners that condom use would not be bad for “business,” but would instead promote the health and therefore the “productivity of their employees.” (3) But since these pimps, as well as the clients of prostitution, tend to see prostituted women as interchangeable, there was little change in behaviour, so the safe sex education was basically limited to the prostituted women. In fact, the harm reduction efforts tended to place the onus on the prostituted women to protect themselves (for example, by suggesting techniques for negotiating condom use or encouraging them to use female condoms as a way to avoid such negotiations) and to take the client’s point of view (by adapting the “work” to the clients’ irresponsible and potentially violent behaviour).

The Sonagachi project is currently in place in other areas of India and in other developing countries. It is supported by the World Bank and the UN. Although the project is intended to reduce infection rates, it nevertheless continues to keep a segment of the women population in prostitution and legitimizes a practice that exposes women to the risk of infection (as well as to violence by prostitution clients).

Empowering these women should include challenging the institution of prostitution instead of remaining simply a shallow form of empowerment that simply legitimizes men’s right to buy sex. In fact, the problems experienced by prostituted women are not only under their control ; to a large extent they are caused by the clients and pimps. As long as there are no changes in behaviour, it is unlikely that these women will ever become truly empowered.

Distinguishing the problems of addiction and prostitution

Addressing the topic of prostitution generally means discussing the different problems that are related to but do not define prostitution. Prostituted individuals are usually dealing with substance abuse, a factor that often brings them into prostitution in the first place and keeps them from escaping it. Drug use is actually often “necessary” to endure the steady stream of unwanted sexual acts, forcing the prostituted individual into a vicious circle of taking drugs to endure prostitution, and engaging in prostitution to be able to buy drugs. Furthermore, the spread of HIV and STIs is now a reality that individuals in prostitution have to deal with. However, these diseases also do not define prostitution, namely the sale and purchase of sex.

The problem of prostitution is not “solved” by handing out condoms. As well, prostitution is a problem much more complex than substance abuse (not to minimize at all this problem). For the prostituted individual, prostitution is not an “addiction” in itself, far from it (it is almost always dissociating for the person who engages in it) : it is a survival strategy and sometimes a way to feed an addiction (such as to drugs or alcohol). It does not appear to make much sense to treat it the same way as an addiction problem.

American psychiatrist and feminist Melissa Farley has been one of the harshest critics of the harm reduction approach as applied to prostitution. Dr. Farley believes that the harm caused by prostitution is often invisible to society. (4) One reason for this is the libertarian approach to sexuality, which tends to see practically all of its manifestations as a victory over the suffocating moralism that still persists in certain segments of society. Another reason is the rather hasty and erroneous judgment by some supporters of the harm reduction approach, as well as comparisons that do not make any sense.

Melissa Farley believes that prostitution requires other kinds of comparisons. In her writings, she compares it to domestic violence, slavery, sexual harassment, torture, incest and rape. By its very definition, prostitution has much more to do with forms of personal and social violence and exploitation than it does with addicting substances such as drugs and alcohol. Even though it would appear to be obvious, it is surprising to see just how much this dimension is glossed over by many harm reduction researchers and workers. The relationship between prostituted individuals and prostitution is far removed from the relationship between an individual with an addiction and the addicting substance. In prostitution, the prostituted individual is not the one using prostitution, it’s the client who is the user and it is she who is used (she is the “product,” so to speak). If there is a problem of addiction when it comes to prostitution, it would probably be the clients who would be considered “sex addicts.” But yet again, it would be inappropriate to see this type of behaviour the same way as substance abuse : no human being should be treated as a substance to be used.

Challenging prostitution as a form of sexual violence

The parallel that can be drawn between prostituted women and women victims of domestic violence is an interesting one since it allows us to identify the limits of the harm reduction approach. Measures that could be considered for reducing harm have been developed to deal with domestic violence, such as shelters for abused women and emergency resources to deal with psychological distress. Another aspect would be to address domestic violence and allow women to leave an intolerable situation. There have not generally been any attempts to legitimize and legalize domestic violence for the sake of pragmatism. Believing that the solution to prostitution involves setting up supervised and controlled brothels makes one wonder whether there are special areas set up to allow men to abuse their partners without interference.

Applying the harm reduction approach to social problems other than substance abuse is not necessarily appropriate and could constitute a rather simplistic application of an approach that has proven to be effective for addressing addictions. Despite the fact that these issues often affect prostituted individuals, they are not defining characteristics of prostitution itself. It could be argued that individuals in prostitution need support to address their substance abuse and to prevent HIV infection, in cases where it is appropriate, without supporting prostitution itself. Giving women in prostitution access to condoms and clean needles, like other individuals at risk of contracting HIV, must not at all allow us to see prostitution as an activity requiring a harm reduction approach. On the contrary, it must be challenged in the same way as domestic violence.

Prostitution lies on the continuum of sexual violence committed by men against (mostly) women and violates their fundamental human rights. The same way that women who are victims of domestic violence must have access to care and shelters, prostituted individuals as well must have access to care and places able to help them address their physical and psychological issues (addictions, violence, sexually transmitted diseases, etc.), but this must stand in the way of working to eradicate this kind of violence. The many physical and psychological problems experienced by prostituted individuals, like those suffered by victims of domestic violence, should alert us and lead us as a society to fight these phenomena rooted in social inequality.

Lastly, we need to come up with intervention models that, without undermining the harm reduction approach, go much further, challenging the institution of prostitution and gender inequality. We also need to educate governments, international organizations, researchers, social workers, the public and individuals in prostitution themselves about the intrinsic harms of prostitution. Beyond simply reducing harm, we need to come up with solutions to help reduce demand (by clients), stop bringing girls into prostitution and eliminate the harms of prostitution as an institution and its violence and exploitation.

Rhéa Jean has completed a PhD in Philosophy (2011) from the Université de Sherbrooke and Université Laval. Her thesis was about how prostitution limits women’s sexual autonomy. Since then, she has been a postdoctoral researcher at the University of Luxembourg (Luxembourg). She has published mainly on feminism and on the question of prostitution. She is also a founding member of La CLES (Concertation des luttes contre l’exploitation sexuelle - the Concertation of Struggles Against Sexual Exploitation), a NGO based in Montreal (active since 2004) seeking alternatives for women involved in the sex industry, and is frequently invited by different organizations to share her view on the ethical questions raised by prostitution.

Rhéa Jean has completed a PhD in Philosophy (2011) from the Université de Sherbrooke and Université Laval. Her thesis was about how prostitution limits women’s sexual autonomy. Since then, she has been a postdoctoral researcher at the University of Luxembourg (Luxembourg). She has published mainly on feminism and on the question of prostitution. She is also a founding member of La CLES (Concertation des luttes contre l’exploitation sexuelle - the Concertation of Struggles Against Sexual Exploitation), a NGO based in Montreal (active since 2004) seeking alternatives for women involved in the sex industry, and is frequently invited by different organizations to share her view on the ethical questions raised by prostitution.